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Public Health Act

What is the Public Health Act?

The Public Health Act was signed into law on July 3, 1944 by President Franklin Roosevelt.  The law officially created a national institution for the promotion of the general health of citizens and service members in the United States.

The law is actually an amendment to the Public Health Act of 1798 which was signed into law by President Adams.  That law instituted policies that insured specific policies concerning the health of military personnel, specifically marines.

The Public Health Act of 1944 significally  expanded the previous law by creating an executive administrative agency with the sole goal of making and implementing health policy in the United States.

The Public Health Act created 4 agencies: The National Institute of Health, The Bureau of Medical Services, The office of the Surgeon General, and the Bureau of State Affairs.  These agencies are supervised by the Surgeon General of the United States who is appointed by the President, for a 4 year term, with the advice and consent of the Senate.

The Act was amended in 1995 and the agencies were reorganized to 8 including:

• Agency for Toxic Substances and Disease (ATSDR)

• Agency for Healthcare Research and Quality (AHRQ)

• Centers for Disease Control and Prevention (CDC)

• Food and Drug Administration (FDA)

• Health Resources and Services Administration (HRSA)

• Indian Health Service (IHS)

• National Institutes of Health (NIH)

• Substance Abuse and Mental Health Services (SAMHSA)

Policy

The policy behind the Public Health Act is to "encourage, cooperate with, and render assistance to other appropriate public authorities scientific institutions, and scientists scientists in the conduct of, and promote the coordination of, research, investigations, experiments, demonstrations, and studies relating to the causes, diagnosis, treatment, control, and prevention of physical and mental diseases and impairments. of man, including water purification, sewage treatment, and pollution of lakes and streams."

Section 330 of the Public Health Act

Section 330 of the Public Health Act, as currently amended provides that "The Secretary shall establish a pilot program to test the impact of providing at-risk populations who utilize community health centers funded under this section an individualized wellnessplan that is designed to reduce risk factors for preventable conditions as identified by a comprehensive risk-factor assessment"

Essentially, this section of the Public Health Service Act allows federal grant funding opportunities for organizations to provide care to underserved populations. Types of organizations that may receive 330 grants include: Community Health Centers, Migrant Health Centers, Health Care for the Homeless Programs and Public Housing Primary Care Programs.  

Section 351 of the Public Health Service Act

In 1999, due to the prevalence of blood borne pathogens, such as HIV, the federal government amended section 351 of the Public Health Act to require a more streamlined and safer method of dealing with the transport, in interstate commerce of human tissue and blood products.  Section 351, as amended, requires a license for transport of these products as well as a homogenous method of operation that is standard throughout the country.  It also regulates the transportation of those products that may be radioactive.

Section 351 of the Public Health Service Act defines a biological product as a “virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood component or derivative, allergenic product, or analogous product applicable to the prevention, treatment, or cure of a disease or condition of human beings.” FDA regulations and policies have established that biological products include blood-derived products.

Patient Protection and Affordable Care Act of 2010

The Patient Protection and Affordable Care Act (PPACA) of 2010 was signed into law on March 23, 2010 by President Barack Obama.  The legislation seriously amends the Public Health Service Act and reforms the private health insurance and public health insurance industries.  Some of the highlight of the law include increasing coverage for pre-existing medical conditions expanding access to medical insurance and increasing medicare expenditures.  

Some of the provisions of the bill include:

• require insurers to offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions. 

• A shared responsibility requirement, commonly called an individual mandate.  This requires that nearly all persons not covered by Medicare, Medicaid, or other insurance programs purchase and comply with an approved insurance policy or pay a penalty

• Medicaid eligibility is expanded to include all individuals and families with incomes up to 133% of the poverty level.

• Low income persons and families above the Medicaid level and up to 400% of the poverty level will receive federal subsidies on a sliding scale.

• Minimum standards for health insurance policies are to be established and all annual and lifetime coverage caps will be prohibited. 

• Firms employing 50 or more people but not offering health insurance will also pay a shared responsibility requirement if the government has had to subsidize an employee's health care. 

• Very small businesses will be able to get subsidies if they purchase insurance through an exchange. 

• Insurance companies are required to spend a certain percent of premium dollars on medical care improvement; if an insurer fails to meet this requirement, a rebate must be issued to the policy holder. 

• Cop-payments, and deductibles are to be eliminated for select health care insurance benefits considered to be part of an "essential benefits package" for Level A or Level B preventative care. 

• Changes are enacted that allow a restructuring of Medicare reimbursement from "fee-for-service" to "bundled payments." 

• The creation of a national voluntary insurance program for purchasing community living assistance services and support. 

• Additional support is provided for medical research and the NIH 

The Penalty for not having insurance

Under PPACA there is currently no penalty for not possessing insurance.  However, effective January of 2014 each individual who does not possess any form of health insurance will be fined $95 or 1% of their annual income, whichever is greater.  This will expand to a $695 penalty or 2.5% of an individual's income in January of 2016.

Controversy over the Patient Protection and Affordable Care Act

There have been 5 cases that have gone to the Federal Circuit of the United States in consideration of the constitutionality of the Patient Protection and Affordable Care Act.  The arguments have mostly stemmed from the constitutionality of the law to regulate the purchase of health insurance.  The main argument is that the purchase and sale of health insurance is a strictly intrastate activity and that it cannot be regulated by Congress through the commerce clause.  One case in Virginia argued that the provision requiring the purchase of health insurance was equal to a penalty imposed those who do not have the minimal protection.  This argument was disregarded by the Federal Circuit.

Proponents for the bill claim that the insurance mandate is not a penalty but requires that all Americans pay into the system so that no one gets a "free ride."  The Supreme Court is scheduled to rule on the matter as soon as the 2012 session.

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